Maternal, Child Health and Neonatal Nursing Commons^™

Nursing Partnership With Patients, Parents And Families For Safety Through Simulation, Courtnay Caufield

Doctor of Nursing Practice (DNP) Projects

Abstract

Problem: The importance of communication between nurses, patients, and their family members with respect to treating each other as partners in safety cannot be overstated. It is imperative that families and patients feel empowered to speak up and report clinical errors at any time and be able to communicate effectively to prevent harm and encourage communication.

Context: This is especially important in the acute care setting, where patients may be in contact with multiple people and processes daily. Attention to this safety partnership can be established through improvements in patient satisfaction scores, which are usually collected from patients and …

Effects Of An Educational Intervention On Exclusive Breastfeeding Rates In Marshallese Mothers Residing In The U.S., Connor K. Otto

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Background: The largest population of Marshallese immigrants in the Contiguous U.S. resides in Northwest Arkansas. Despite adequate access to healthcare, the Marshallese face many health disparities, perhaps partly due to the language barrier they face in healthcare settings and education. Regarding breastfeeding rates, women in the Marshall Islands have a significantly higher rate of exclusive breastfeeding than in Marshallese women residing in the U.S. who face cultural barriers. Breastfeeding is positively correlated to many benefits for infants and is recommended exclusively for at least 6 months by pediatric policy organizations.

Objective: The purpose of this research is to examine breastfeeding …

Community Doula Services For Low-Income Population And Its Correlation To Hospital Re-Admissions Of Newborns, Eva Perez

Grace Peterson Nursing Research Colloquium

Abstract

This integrative literature review seeks to identify a correlation between an expectant mothers’ lack of familial support and lower socioeconomic status and their newborn baby’s hospital admission(s). Various journals and research studies demonstrate that when mothers have added support from community doulas, both mother and baby tend to have a more positive experience. Participants in the different studies included minority women under the age of 21 and women of lower socioeconomic status. A study conducted in rural Nepal showed that the mortality for newborn babies, specifically those with low birth weight (LBW) had sharply declined when they had home …

Preventing Postpartum Depression In Women Living In The United States: An Integrative Literature Review, Melanie Rein, Natalie Allen

Grace Peterson Nursing Research Colloquium

Abstract

Background: Postpartum depression (PPD) is common among women living in the United States (U.S.). Unfortunately, despite its prevalence, PPD is underdiagnosed and undertreated. This can have serious consequences for both mother and baby. Research suggests that there is a need for further understanding of interventions to prevent PPD.

Objectives: The purpose of this integrative literature review is to examine strategies that can be used as prevention interventions for PPD.

Methods: An integrative literature review was conducted to identify research supporting PPD prevention. Research was collected by accessing databases through DePaul University Library and was organized according …

Wic Professionals’ Adaptations In Clinical Practice To Better Assess And Address Household Food Insecurity In Participating Families, Kristal Kim

Grace Peterson Nursing Research Colloquium

Abstract

Background: While research on Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participation and proximal health indicators has been considerable, literature on best practices for assessing and addressing household food insecurity in public health clinics remains limited. The purpose of this study was to examine WIC professionals’ knowledge and perspectives of household food insecurity among WIC program participants.

Method: During January 2018, we conducted four focus groups utilizing a semi-structured interview guide with public health staff (N = 24) across four public health districts in Midwestern counties. WIC staff included social workers, nurses, nutritionists and ancillary staff. …

Trying To Cover The Sun With Your Thumb: A Critical Ethnography Of Maternity Care Provision In Rural Northern New Mexico, Abigail Reese

Nursing ETDs

Access to maternity care is disappearing for women across rural America. In the state of New Mexico, women often travel long distances to access hospitals and providers that offer childbirth services, as these resources are concentrated primarily in metropolitan areas. Although data on provider distribution is available, very few studies have explored the maternity care access crisis from the perspectives of the midwives and physicians who work in rural areas. The purpose of this critical ethnographic study was to explore barriers and facilitators to the provision of childbirth services from providers’ perspectives with the intent of informing policy debates around …

Quality Of Care Strategies And The Subsequent Improvement Of Kangaroo Care Incidence Rates In Premature Infants, Sarah Anderson

Posters-at-the-Capitol

Purpose: The benefits of kangaroo care (KC) has long been studied and proven. Despite the research, incidence rates of KC are low in the neonatal ICU at the Kentucky Children’s Hospital. Some barriers to KC exist in our NICU and this study strives to address them. This study aims to develop and implement strategies to increase utilization of KC from 41% to  75% for eligible infants.

Methods: KC occurrence was monitored in 364 infants with birth weight ≤ 1250 grams. Strategies implemented were education of nurses, improved nurse-to-patient ratio, emphasis of KC in multidisciplinary rounding, improved documentation, …

The Ties That Bind: Cradling In Tajikistan, Lana B. Karasik, Catherine S. Tamis-Lemonda, Ori Ossmy, Karen E. Adolph

Publications and Research

A traditional childrearing practice—“gahvora” cradling—in Tajikistan and other parts of Central Asia purportedly restricts movement of infants’ body and limbs. However, the practice has been documented only informally in anecdotal reports. Thus, this study had two research questions: (1) To what extent are infants’ movements restricted in the gahvora? (2) How is time in the gahvora distributed over a 24-hour day in infants from 1–24 months of age? To answer these questions, we video-recorded 146 mothers cradling their infants and interviewed them using 24-hour time diaries to determine the distribution of time infants spent in the gahvora within a day …

Exome Sequencing Identifies Gene Variants And Networks Associated With Extreme Respiratory Outcomes Following Preterm Birth, Aaron Hamvas, Rui Feng, Yingtao Bi, Fan Wang, Soumyaroop Bhattacharya, Jared Mereness, Madhurima Kaushal, C Michael Cotten, Philip L Ballard, Thomas J Mariani

Faculty, Staff and Student Publications

BACKGROUND: Previous studies have identified genetic variants associated with bronchopulmonary dysplasia (BPD) in extremely preterm infants. However, findings with genome-wide significance have been rare, and not replicated. We hypothesized that whole exome sequencing (WES) of premature subjects with extremely divergent phenotypic outcomes could facilitate the identification of genetic variants or gene networks contributing disease risk.

RESULTS: The Prematurity and Respiratory Outcomes Program (PROP) recruited a cohort of > 765 extremely preterm infants for the identification of markers of respiratory morbidity. We completed WES on 146 PROP subjects (85 affected, 61 unaffected) representing extreme phenotypes of early respiratory morbidity. We tested for …

Mother Baby Discharge Process, Zander Abbott, Maria Tkacz, Suellen Clark, Justyna Coleman, Dave Cox, Kathy Cyr, Sharon Economides, Jen Johnson, Stacy Lamore, Mary Mcnulty, Joy Moody, Heidi Morin, Cathy Palleschi, Josh Sinkin, Stephen Tyzik, Helen Wild

MaineHealth Maine Medical Center

Problem/Impact Statement: MMC's 32-bed Mother Baby Unit is experiencing backed up flow due to high volume and patients not being discharged quickly enough. The current average discharge time on Mother Baby and the Newborn Nursery is 1:36pm. The Mother baby unit has 32 beds, is staffed by 8-9 nurses, and has average discharge of 91 patients a week.

Bringing The Nicu Rn To The Family, Gale Price, David Hicks, Terry Zeilinger

Articles, Abstracts, and Reports

After reviewing the current literature on perinatal hospice and meeting with the established team at St. Joseph Hospital, St. Jude Medical Center decided to form a team and provide training to all of the Maternal Newborn division on how to care for these families

“I Should Have Started Earlier, But I Was Not Feeling Ill!” Perceptions Of Kalenjin Women On Antenatal Care And Its Implications On Initial Access And Differentials In Patterns Of Antenatal Care Utilization In Rural Uasin Gishu County Kenya, Roselyter Riang’A, Anne Nangulu, Jacqueline Broerse

Population Health, East Africa

Aim: The aim of this study was to explore how Kalenjin women in rural Uasing Gishu County in Kenya perceive antenatal care and how their perceptions impede or motivate earlier access and continuous use of antenatal care services.

Methods: A study was conducted among 188 pregnant and post-natal mothers seeking care in 23 rural public health facilities. Gestational age at the initial antenatal care booking was established from their medical cards. Further researcher-administered questionnaire with closed and open-ended questions was used. Key informant interviews with traditional birth attendants (n = 6) and maternal and child health nursing officers (n = …

Improving Analgesia Administration For Pediatric Patients In A Rural Emergency Department, Alvin R. Walters

DNP Qualifying Manuscripts

When a child is in pain, parents often seek out treatment at an emergency department. After a detailed chart review it was determined that only 32.53% of the pediatric patients who present to a rural, northern California, ED in pain receive any documented form of analgesia during their time in the ED. A review of the literature revealed that triage nurse-initiated protocols can successfully manage to provide consistent and efficient analgesia to patients who present to an ED with pain. Therefore, a practice improvement project was undertaken to increase of the consistency and efficiency of analgesia administration for pediatric patients …

Nicu Nurses' Suggestions For Improving End-Of-Life Care Obstacles, Renea L. Beckstrand, Rebecca F. Isaacson, Janelle L. B. Macintosh, Karlen E. Luthy, Lacey Eden

Faculty Publications

Background: Neonatal deaths (infants less than 28 days old) account for two thirds (66.7%) of all infant deaths with most occurring in an ICU setting. NICU nurses are frequently involved in end-of-life (EOL) care and face unique obstacles.

Objective: The objective of this study was to obtain NICU nurses’ suggestions for improving obstacles in EOL care in NICUs.

Methods: Suggestions were obtained through mailed survey research in qualitative study design. Returned surveys yielded 121 nurse respondents who gave a total of 138 suggestions.

Results: A total of 10 cohesive themes were identified: (1) environmental design issues, (2) improved communication between …

Pediatric Primary Care Concussion Evaluation And Management, Kaitlyn Layman

Doctoral Dissertations and Scholarly Projects

Concussions are an important and timely subject, especially within the pediatric population, as they are the most involved in extracurricular contact sports and are susceptible to concussions and their sequelae. The researcher performed a quasi-experimental pilot study in a pediatric primary care office where the researcher educated 15 providers on the HEADS UP concussion screening tool and management approach. The researcher gave providers pre- and post-intervention surveys to determine if providers’ comfort and knowledge regarding assessing and managing concussions within the pediatric primary care setting changed. Four providers participated in the study. The researcher conducted a chart review two months …

Common Components Of Fetal Alcohol Spectrum Disorder Prevention Intervention Programs: A Review Of Literature, Ross Siemering

Grace Peterson Nursing Research Colloquium

Abstract

Background: Fetal alcohol spectrum disorders (FASD) are the most common yet completely preventable cause of mental disability in the western world.

Objective: The purpose of this integrative literature review is to examine and identify the common elements among varying interventions for FASD prevention that have demonstrated effectiveness for reducing the risk of FASD to better understand what defining features may contribute to the efficacy of the interventions.

Methods: An integrative literature review was conducted. The databases searched included: CINAHL, PubMed, Cochrane Library, and Science Direct. Articles were then reviewed to determine if they were appropriate for inclusion based upon …

Developmental Interventions Used For Premature Infants In The Nicu, Macy Swanager

Grace Peterson Nursing Research Colloquium

Developmental Interventions Used for Premature Infants in the NICU: An Integrative

Literature Review

Macy Swanager

Research Advisor: Kim Amer, PhD, RN

Abstract

Background: Various developmental interventions have been used to promote premature infants’ health in the NICU, but there has been limited research on which of these interventions leads to the best outcomes in reducing stress-based symptoms in the premature infant.

Objectives: The purpose of this integrative literature review was to assess the current trends in developmental intervention strategies that are being used in the NICU that result in positive outcomes in premature infants.

Method: An integrative literature review was …

Maternal Mortality In Non-Hispanic Black Women, Amelia Major

Grace Peterson Nursing Research Colloquium

Background: The United States has the highest maternal mortality among all developed countries, among these mothers, non-Hispanic black women are three times more likely than women of any other racial group to die from pregnancy-related causes.

Purpose: To investigate racial disparities among pregnant women who die from pregnancy related causes (maternal mortality) and determine possible interventions to improve outcomes.

Methods: An integrative literature review was conducted to analyze peer-reviewed articles published from 2007 to 2018; a computerized search of literature was performed using Cumulative Index to Nursing and Health Literature (CINAHL), Proquest Nursing and Allied Health Sources, …

Determining Risk Factors To Decrease Maternal Mortality Related To Chronic Hypertension: An Integrative Literature Review, Chelsea Stellmach

Grace Peterson Nursing Research Colloquium

Background: Maternal mortality ratio (MMR) in the United States in 2015 was 26.4, higher than many other developed countries. Maternal deaths due to hypertensive disorders of pregnancy are on the rise, including chronic hypertension. Chronic hypertension is defined as blood pressure greater than or equal to 140/90 mmHg before pregnancy or during the first 20 weeks of gestation. This condition occurs in up to 5% of pregnancies which are more likely to result in adverse maternal outcomes. Nearly 40% of maternal deaths are preventable, especially those related to chronic diseases.

Objectives: The purpose of the integrative literature review was to …

Implementation Of A Transcutaneous Bilirubinometer On A Postpartum Unit At A Magnet Community Hospital, Riley O'Connell

Master's Projects and Capstones

A common clinical concern for all newborns in the first few days of life is the risk of hyperbilirubinemia. Hyperbilirubinemia if left untreated can lead to permanent hearing loss, neurological dysfunction, and even irreversible brain damage called kernicterus. Bilirubin monitoring and early intervention can prevent these adverse events from occurring. Best practice recommends the use of transcutaneous bilirubin (TcB) monitoring on all term, low-risk newborns (>38 weeks gestation at birth) at 24-hours of life. Replacing total serum bilirubin (TSB) draws through a heel stick, with TcB assessments leads to utilization of evidence-based practice. The transcutaneous bilirubinometer is a non-invasive, …

Experiences Of African American Mothers Following Infant Death, Katina W. Jones

Nursing Theses and Dissertations

African American women have been disproportionately affected by unfavorable birth outcomes for decades. Infant mortality rates for non-Hispanic African American women have been almost twice as high as that of Caucasian women for years. The goal of this study was to: (1) understand African American mothers’ experiences with infant death and (2) discover how African American mothers manage their grief following the loss of an infant. A review of the literature revealed African American women experience infant loss at a rate of 13.31 deaths per 1,000 live births compared to 5.63 for Caucasian women and 4.75-9.22 for other racial and …

Postpartum Hemorrhage: A Change Strategy, Alison Landis

Master's Projects and Capstones

Problem: Postpartum hemorrhage (PPH) is one of the leading causes of severe maternal morbidity and mortality. It is unpredictable and can occur with or without identified risk factors. A postpartum hemorrhage can happen rapidly, therefore it is important for the team to be trained and prepared to recognize and respond quickly to the situation, by quantifying blood loss at deliveries.

Context:The California Maternal Quality Care Collaborative (CMQCC) has created a toolkit to better prepare maternal child health teams for readiness, recognition, response, and reporting when a hemorrhage occurs. This program was rolled out on the unit in 2015 resulting …

Improving The Timing Of Antibiotic Administration In High-Risk Neonates, Jed Comuelo

Master's Projects and Capstones

Improving the Timing of Antibiotic Administration in High-Risk Neonates

Abstract

Problem: The rapid nurse turnover and improper use of the golden hour flowsheet are some of the factors that affect the timing of antibiotic administration. A review of 38 patient charts was done and only shows 20% received antibiotics within 1 hour.

Context: This microsystem is a 22-bed neonatal intensive care unit with an average of 900 admissions per year. The team is composed of doctors, nurses, respiratory therapist, and pharmacists. The budget needed for this project consists of the overtime pay needed to compensate nurses for attending additional staff …

Simulation Course Redesign, Hsuan Ho

Master's Projects and Capstones

The purpose of this project is to enhance the clinical nurse leader (CNL) nursing students’ learning experiences through simulation education, ensure that their learning outcomes meet course objectives, and increase students’ recognition of educational best practices in simulation.

This summer semester, the number of students in the obstetric course doubled and the course was changed from four scenarios held over two simulation days for four pre-licensure students each class to five simulation days with eight to ten students in attendance each class period. While the old student-to-instructor ratio was three to four to one, the new ratio is nine to …

Optimizing The Involvement Of Women With Opioid Use Disorder In The Care Of Their Infants Experiencing Neonatal Abstinence Syndrome, Rebecca Boedeker

Dissertations

The incidence of opioid use disorder (OUD) has grown to epidemic proportions. Infants exposed to opioids inutero are likely to experience withdrawal symptoms during the hours and days immediately following birth, known as Neonatal Abstinence Syndrome (NAS). Research indicates maximizing non-pharmacologic, supportive management decreases Neonatal Intensive Care Unit (NICU) admissions, the length of stay, and the severity of NAS. The purpose of this project is to evaluate the effects of an antepartum consult designed to prepare mothers with OUD to participate in this nonpharmacologic care. The Women and Infants Substance Help (WISH) Center delivers prenatal care for women with OUD. …

An Exploration Of Nicu Nursing Staff Perspective On The Change From Pod To Private Room Patient Care, Julie Nickles

Dissertations

Neonatal Intensive Care Units (NICU) are designed to care for critically ill newborns who require constant care. The design of the NICU may have an impact on not only the patient and their family but also the nursing staff. Historically neonatal intensive care have employed a cohort model of care. In this model multiple infants are in the same room or pod. With success of single room maternity care, the increased need for changes in neonatal care became apparent. Today, new parents desire extended contact with their extremely preterm and often very sick infant. This trend has led a standard …

Aligning With Patient-Centered Medical Home Standards: Depression Screening In Women's Health, Charity Galgani

Dissertations

Problem: The Patient Centered Medical Home (PCMH) model of care improves health care quality and patient experience of care, and decreases costs. Depression screening is a requirement for becoming a PCMH. The purpose of this quality initiative was to obtain baseline data to describe depression screening rates among female adult patients receiving women’s health care within a Midwestern public health department seeking PCMH recognition.

Methods: The study utilized a descriptive, observational design and was guided by the Plan-Do-Study-Act framework. A retrospective medical record review was used to assess the rate of depression screening utilizing the PHQ-2 and PHQ-9 tools, and …

Alternatives In Magnesium Sulfate Treatment Courses: An Investigation Of Physician Prescribing Behaviors, Erin Williams

Dissertations

Problem: The gold standard for managing preeclampsia in the postpartum patient is 24- hours of magnesium sulfate as this is the time the patient is most susceptible to experiencing a seizure (American College of Obstetricians & Gynecologists, 2013). However, these patients are at an increased risk for experiencing adverse health outcomes, as well as interruptions in maternal-infant bonding due to the mother requiring a higher level of care. Methods: A one group pretest-posttest design was conducted to gain a better understanding of the current practice while also assessing the willingness of physicians to change prescribing behavior after receiving the research-based …

Journey Interrupted: A Phenomenological Exploration Of Miscarriage, Marit A. Watson, Vanessa D. Jewell, Sarah L. Smith

The Open Journal of Occupational Therapy

Background: Miscarriage is a significant life event that impacts occupational performance, identity, and competence and that influences perceptions of motherhood. Because of the lack of social rituals often attributed to the death of a loved one, miscarriages may result in disenfranchised grief, which impedes coping.

Methods: This phenomenological study explored the impact of miscarriage on relationships, perceptions of motherhood, and the meaning of occupation in the context of grief. Data was collected through semi-structured interviews (N = 4) and completion of a brief demographic questionnaire. The interviews were digitally recorded, transcribed verbatim, and reviewed to ensure accuracy. Using inductive thematic …

The Association Of Kangaroo Mother Care, Energy Conservation, And Bonding In Preterm Neonates, Dorothy Forde

Dissertations

Purpose:To examine the association of kangaroo mother care (KMC) on energy utilization and bonding as evidenced by reduced biochemical markers of adenosine triphosphate (ATP) degradation, hypoxanthine (Hx), xanthine (Xa), and uric acid (UA), and (allantoin), a measure of oxidative stress in preterm infants 24-36 weeks gestation. A secondary objective was to compare specific physiological parameters using bedside monitoring and perfusion and oxygenation of the gut using near-infrared spectroscopy (NIRS) during 1 hour of KMC compared to incubator care.

Study design: A randomized controlled trial (RCT) examining the effects of 1-hour of KMC or 1-hour incubator care on urinary markers …